This Issue

Glaucoma

Still at risk - even with 20/20

The day-to-day challenge of living with
low vision

Q & A

A closer look

To check a particular doctor’s background, contact the Massachusetts Board of Registration in Medicine at (800) 377-0550 or visit http://profiles.massmedboard.org/MA-Physician-Profile-Find-Doctor.asp.

The profile will give:

• Date of licensure in Massachusetts

• Education and training (residency)

• Medical specialties

• Board certification(s)

• Professional information

Address and telephone number
Insurance plans accepted
Hospital affiliations
Availability of translation services

• Awards, research and publications

• Malpractice claims paid, hospital discipline and criminal convictions in the past 10 years

• Disciplinary actions of the Massachusetts Board of Registration in Medicine in the past 10 years

A closer look

Are you at risk?

Like looking through
a tunnel

Support group meeting

The best
attack against glaucoma

Types of primary care providers




  • Internist — treats adults of all ages

  • Pediatrician — treats children from birth to age 18

  • Family practitioner — treats the entire family regardless of age

  • Geriatrician — treats elderly people with complex and multiple diseases

  • Gynecologist — treats females usually of child-bearing age

  • Nurse practitioner and physician assistant — provide primary care under the supervision of a doctor

Personal health journal

A personal health journal — a handy tool for both you and your doctor — is simply a collection of information about your health that you gather and manage. The journal should include not only the names and numbers of your doctors, but lifestyle goals as well. Your health information should be accurate, detailed and current.

A health journal should include:

  • Illnesses and injuries
  • Hospitalizations
  • Surgeries
  • Diagnostic tests, such as X-rays and scans
  • Screening tests
  • Treatments and procedures
  • Allergies
  • Immunizations
  • Medicines, including exact name and dosage
  • Over-the-counter vitamins and supplements
  • Family history of diseases

Be sure to include dates. For instance, if you are hospitalized, make note of the date admitted and the date of discharge. Be specific. If you have had abdominal surgery, specify the type. You do not need to include minor illnesses, such as coughs and colds. Take your journal to your doctor’s appointments.

For more information on developing a family health history

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.


Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon
617-638-8260

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
617-636-1664
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
617-573-3340
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.
781-326-4600

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
617-726-0218
Remember to call ahead to confirm
time and date
of screenings.

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Support Group Meeting

Date: Saturday, February 4th
Time: 10 a.m.
Location: Mass Eye and Ear Infirmary
243 Charles Street, Boston
8th floor board room

Please RSVP
Catherine Duffek
617-797-6476

Glaucoma
Early detection of vision loss key to avoiding “thief of sight”



(From left to right): Demetri Flaherty, grandmother, Nancy Beckford, mother, Shelley Flaherty and twin brother, Chance Flaherty. Demetri, Nancy and Chance have been diagnosed with glaucoma, which tends to run in families. (Ernesto Arroyo photo)

It all started five years ago when Chance Flaherty, then 14, could not read the Jumbotron at a Celtics game. Nor could he see the numbers on the back of the players’ jerseys.

His mother, Shelley, acted quickly and took Chance to an optometrist for an eye exam. But she wasn’t prepared for what the optometrist told her. It was not the nearsightedness that caused alarm. The pressure in both his eyes was elevated. The optometrist knew that increased eye pressure, or glaucoma, tends to run in families.

As a result, he recommended that the entire family make appointments as well. Everyone tested normal. But not Demetri, Chance’s twin brother.

He was experiencing vision problems of his own. He was in the ninth grade at Community Charter School of Cambridge when things began to go awry. Demetri admitted that he had trouble seeing the black board at times, but a simple change of seats remedied the short-term problem.

The results of Demetri’s eye exam demonstrated a long-term problem. Not only was he nearsighted, but the pressure in both of his eyes also exceeded the normal limit, the right eye worse than the left. Instead of the average eye pressure of 11 to 21 mm Hg (millimeters of mercury) his pressure exceeded 30. It was later determined that both Demetri and Chance had primary open angle glaucoma — the most common form of the disease.

Without much warning or fanfare more than two million people in the United States slowly begin to lose their sight. And they don’t even know it. According to experts, by the time they notice a change, more than 50 percent of their vision has been permanently lost.

Most often the first symptom is the loss of peripheral or side vision. That’s why it escapes notice. You don’t need peripheral vision to watch TV, work on the computer or read. But there’s another reason for the lack of awareness, according to Dr. Douglas J. Rhee, an ophthalmologist at Massachusetts Eye and Ear Infirmary. “The brain does funny things,” Rhee said. But it’s not trying to play tricks; it is actually being protective. Glaucoma causes blind spots in our vision, so the brain fills them in for us, Rhee explained.

Yet, without treatment, glaucoma — the second leading cause of blindness in this country — slowly advances. Eventually, the scope of vision is so limited, it’s as though one is looking through a tunnel or telescope. Ultimately, the disease can result in permanent and total vision loss.

No one — not even babies and children — is safe from glaucoma. African Americans and Hispanics are afflicted more. And earlier. Glaucoma often strikes blacks around the age of 40. Asians are also afflicted, but tend to suffer from a less common form of glaucoma.


Douglas J. Rhee, M.D.
Glaucoma Specialist
Massachusetts Eye and Ear Infirmary
By 60, everyone is fair game.

Glaucoma results from increased eye pressure. The eye is filled with and nourished by a clear fluid that continually flows, but must drain to accommodate a fresh incoming supply. In most types of glaucoma the fluid does not drain properly causing eye pressure to rise.

Elevated pressures can eventually destroy the optic nerve, a bundle of more than one million nerve fibers that connects the retina (tissue at the back of the eye) with the brain. A healthy optic nerve is necessary for good vision.

Glaucoma is not one disease. Rather, it is a family of several different types. Congenital glaucoma is rare and develops in infants and young children. Secondary glaucoma results from another cause, such as an eye injury or long-term use of corticosteroids.

In low tension glaucoma, which affects up to one third of people with the disease, eye pressure remains within the average range, but still results in optic nerve damage.

A more severe form is acute closed-angle glaucoma. It results from a sudden and complete blockage causing severe eye pain, blurred vision, headaches and nausea. This form of glaucoma is a medical emergency and requires immediate treatment.

The most common form of glaucoma — primary open-angle glaucoma — is frequently referred to as the silent thief of sight. In Demetri’s case, even the doctor was surprised. “The doctor didn’t want to believe it,” Demetri said. “You’re too young.” A second opinion, however, confirmed the initial diagnosis.

Demetri’s reaction was one of disbelief as well. “I was surprised,” he said. “I didn’t know it existed.”

Demetri had a long haul ahead of him. The eye drops he was prescribed worked — but not well enough. He said that his pressure dropped but not to the levels that doctors were hoping. Two years ago he had laser surgery to open up the drainage in his right eye.

So far so good. The surgery combined with three types of eye drops he takes daily is keeping his pressure in check despite some minor side effects. “Sometimes the medicine stings,” he said. “And my eyes are always red.”

A closer look at glaucoma

Source: American Academy of Ophthalmology
He admitted it took some doing to master the eye drops. “You have to be careful that the nozzle does not touch the eye,” he explained. And you have to tilt your head back just right. Air bubbles, he said, can be deceiving. They feel wet, but contain air instead of medicine.

Demetri perfected his technique by practicing with his grandmother. She also has glaucoma and was caught by surprise as well. Nancy Beckford, 55, was playing around with a friend some years back. They were singing along with the Hall and Oates song “Private Eyes.” As she sang “we’re watching you,” Beckford playfully closed her left eye to simulate a watchful eye.

“It was blurry around the edges of my vision,” she said, describing impaired peripheral vision. “It wasn’t clear.” An eye exam confirmed the diagnosis.

Though it is not possible to prevent glaucoma, the disease can be detected early before it causes serious damage. A comprehensive eye exam does the trick. The American Academy of Ophthalmology recommends that at age 40 adults with no signs or risk factors for eye disease should have a comprehensive baseline screening. But Rhee is quick to point out that people of high risk — especially blacks and those with a family history — should start earlier. Intervals for follow-up examinations will be based on the findings. Usually exams are recommended every one or two years.

Timing is the key. Vision lost from glaucoma cannot be regained.

Demetri has not escaped the disease unscathed. He has lost some peripheral as well as central vision in his right eye, but his left eye compensates.

According to Demetri, his condition hasn’t slowed him down. Nor has it forced him to change his study of interest. Despite his impaired vision, he’s a sophmore at Massachusetts College of Arts and Design with an interest in industrial design.

“You get used to it,” he said.